Tuesday, June 25, 2019

This ought to be well enough known by now, but apparently it isn’t. Every time a high profile individual commits suicide the media issues some well intended advice, to the effect that we need to have a national conversation about depression. And it always adds, wistfully, that if only the victim could have received proper treatment.

And yet, many of these suicide victims were receiving mental health treatment. As I noted in my post about Lauren Slater, psychiatric treatment seems to be doled out haphazardly. It produces some very unpleasant side effects. And besides, we ought to emphasize, yet again, a simple fact, known to all physicians and psychopharmacologists: namely, that antidepressant medication, especially SSRIs, comport a suicide risk.

Experts last night warned that patients should be told of the dangers before they start taking the pills.

The research found depressed people on the drugs were more than twice as likely to attempt suicide as similar patients who were not taking them.

Study leader Dr Michael Hengartner, of Zurich University in Switzerland, said: ‘We can be confident that these drugs are producing an excess rate of suicides, beyond the depression itself.

‘There is no doubt that this must be a response to the pharmacological effect of the drugs themselves.’

Although the increased risk appears stark, in real terms the researchers calculated only 77 extra suicides per 100,000 patients taking the pills.

Scientists acknowledge that for many people, antidepressants are a lifeline.

Given that the Daily Mail is a British publication, it emphasizes how these medications are being prescribed in Great Britain:

But with more patients in Britain taking them than those in almost every other Western country, many doctors believe millions are being put at risk.

Some seven million adults in England took the drugs in 2016/17. The researchers believe that for some, the chemicals in the pills can trigger severe agitation, restlessness and even psychotic episodes.

Dr Hengartner added: ‘I’m not saying no one should be given antidepressants, but doctors should be much more conservative about how they use them. One in six adults being given antidepressants like in the UK – that is alarming.

How bad is the risk?

The study found that people prescribed antidepressants were 2.5 times more likely to attempt suicide than depressed people taking placebo pills.

The research, published in the journal Psychotherapy and Psychosomatics, combined the results of 14 studies involving nearly 32,000 people taking a variety of antidepressants.

The authors stressed that the real-terms rise in risk was small, calculating that for every 100,000 taking the pills, there would be an extra 413 suicide attempts and an extra 77 suicides. But in England, this could add up to thousands of extra suicides.

The highest risk was found to occur in the first four weeks after the treatment begins.

And yet, the data for the study comes from the United States, of all places:

Professor Wendy Burn, president of the Royal College of Psychiatrists, pointed out that the study was based on US data, and four of the 14 drugs assessed are not available in the UK.

But she added: ‘This is an important issue, which we need to understand better. As with all medications, we need to balance the potential benefits and risks of harm from starting, continuing and stopping their use.

‘It is vital that people prescribed antidepressants are monitored closely, made aware of possible side effects and know how to seek help if they experience them.’

This ought not to be news. Strange to say, it is. And suicide is not the only risk factor, to being on or coming off the drugs:

Last month, the Royal College of Psychiatrists acknowledged for the first time that coming off the pills can cause severe side effects lasting months – with the worst-hit suffering nausea, anxiety and insomnia.

And two weeks ago, the European Medicines Agency issued guidance suggesting the most common pills – selective serotonin reuptake inhibitors or SSRIs – can cause long-term loss of sexual function.

Aside from teaching us that these pills are not a panacea, we all need to be far more aware of the potential bad side effects. Let’s accept that they are beneficial on balance. But, it is strange to see, thirty years after SSRIs were introduced, people coming to a belated awareness that those who take them need to be monitored and warned.

The study focused on modern SSRI's but antidepressants are also known to trigger mania in susceptible individuals. Whether it's unmasking underlying bipolar disorder or inducing it on it's own no one knows. Good times with amitriptyline back in the day. Not really.